Description:

RTOG 0920 OPEN Registration Worksheet Radiation Therapy With or Without Cetuximab in Treating Patients Who Have Undergone Surgery for Locally Advanced Head and Neck Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9FDDB442-DA44-C42C-E040-BB89AD432DB7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9FDDB442-DA44-C42C-E040-BB89AD432DB7

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Versions (3) ▾
  1. 12/18/14
  2. 1/9/15
  3. 9/17/21
Uploaded on:

September 17, 2021

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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Head and Neck Cancer NCT00956007 Registration - RTOG 0920 OPEN Registration Worksheet - 3219099v1.0

No Instruction available.

  1. StudyEvent: RTOG 0920 OPEN Registration Worksheet
    1. No Instruction available.
Module 1
Has the eligibility checklist been completed
In the opinion of the investigator, is the patient eligible?
Race
Demographics
Module 1
Any care at VA or military hospital
Have you obtained the patient's consent for his or her tissue to be kept for use in research to learn about, prevent, treat or cure cancer
Have you obtained the patient's consent for his or her blood to be kept for use in research to learn about, prevent, treat, or cure cancer?
Have you obtained the patient's consent for his or her tissue to be kept for use research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease)?
Have you obtained the patient's consent for his or her blood to be kept for use research about other health problems (for example: causes of diabetes, Alzheimer's disease, and heart disease)?
Have you obtained the patient's consent to allow someone from this institution to contact him or her in the future to take part in more research
Tissue sent for HPV analysis?
Disease Type
If yes, have pre-registration credentialing requirements in Section 5.2 been met?
Module 2
Use of IGRT?

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